Exercise in Parkinson’s: what’s best?
Weights or stretching, cycling or t’ai chi — what types of exercise are good for Parkinson’s?
Earlier this week, we introduced the science of exercise. Part one of this post focused on why exercise is important and what the guidelines say about how much we should be doing. We also found out how exercise may help the brain and what that could mean for those with Parkinson’s.
Here, in part 2, we answer one of the most common questions we’re asked in the Research Team on the topic of exercise…
What exercises are best for people with Parkinson’s?
Researchers are looking at different types of exercise, including t’ai chi, tango dancing, gym and resistance training. Often, exercise studies do not compare different types of exercise side-by-side, so there is no definitive answer to which type of exercise is best.
However, at Parkinson’s UK we know how important it is to have guidance on the best exercise for Parkinson’s. So we’ve been working with leading physiotherapists and built on their extensive clinical experience to develop recommendations about what exercise is most suitable for people with Parkinson’s.
There are different exercise styles depending on how your symptoms affect you. And everyone with Parkinson’s should be looking for exercise that help them to do:
- aerobic activity to get the heart pumping
- exercises that concentrate on strengthening the major muscle groups
- regular stretches that move limbs through the full range of motion
- exercises that focus on, and improve, balance, and
- combined movements that make you think hard as you co-ordinate your four limbs together, or that work your ability to do two or more things at once (known dual tasking) can play an important part of your exercise routine.
In this post we look at what research evidence there is for popular types of exercise that are recommended and enjoyed by people with Parkinson’s.
Aerobic exercise for Parkinson’s
There have been a number of small scale studies of cycling for people with Parkinson’s. Researchers have discovered that some people who experience freezing episodes, may not experience the same difficulties when on a bike. They have even suggested a stable and comfortable sitting posture, which some stationary bikes offer, may help with safety.
While the duration, effort and participants vary between different studies, research suggests that cycling may provide short term improvements in tremor and slowness of movement, walking and the ability to plan and organise.
And some of these benefits may be seen after one exercise session. However, other reported benefits of exercise, such as improved balance, have not been consistently demonstrated for cycling.
Different types of cycling have also been investigated by comparing dynamic and static cycling — in dynamic mode, a motor maintains the speed or the bike, but in static mode, the rider must pedal with no assistance. In the study, the researchers found greater improvements in movements in those who used the dynamic bike than those on the static bike. This was despite the static bike being more of a workout as measured by the participants heart rate.
Another popular activity for people with Parkinson’s is dance. There are many different types of dance, which can either be partnered or solo. Much of the research into dance has involved only small numbers of people and focuses on the benefits perceived by the participant, but there have been studies that use qualitative methods to measure improvements.
This type of activity typically seems to show benefits for movement, walking and balance. Dance is also reported to improve quality of life and mood, particularly as music and social activities enhance our sense of wellness. In addition, some studies suggest improvements in thinking and memory.
While it would appear dance can benefit people with Parkinson’s studies with larger groups of people are needed to better understand how dance benefits the various motor and non motor symptoms of Parkinson’s.
To find a dance activity class near you, visit the Parkinson’s UK website.
Running is perhaps the most common form of aerobic exercise, however walking can also get your heart pumping and be an affordable and fun exercise. And, like dance and cycling, there are different types of walking.
There has been a number of studies into the specific benefits of a type of walking known as Nordic walking, which include improved motor symptoms, balance, quality of life, and (not surprisingly) walking.
Nordic walking has also been compared to normal or ‘free walking’. In one 6 week study involving 33 people with Parkinson’s, Nordic walking was seen to have greater benefits than normal walking, but both groups showed improvements in motor symptoms, balance and mobility.
However, this was still a small study and the researchers state that there is not yet enough evidence that the benefits of Nordic walking are greater than with other types of exercise, such as treadmill training, free walking and other exercise programmes.
If you are interested in taking on a challenge, and meeting other people, Parkinson’s UK hosts a number of walks around the country. With the choice of shorter and longer distances and with locations including some of the UK’s most beautiful parks, countryside and cities, there really is a walk for everyone.
Find out more at: www.parkinsons.org.uk/walkforparkinsons
Other aerobic activities
There any many other types of aerobic exercise. From non-contact boxing that mixes aerobic exercise with muscle building, to water aerobics, which can be useful for reducing stress of joints and may require less balance. While research endorsing the Parkinson’s specific benefits of these activities is more sparse, they can still make up a fun and rewarding part of an exercise regime.
Strengthening and flexibility exercises
Maintaining strength and flexibility is another key part of exercising and can be particularly important for people with Parkinson’s. There are many non- aerobic activities that can help, we recommend asking for advice from physiotherapists who can suggest specific individualised exercises that work at strengthening or stretching particular muscles to help you move easier.
Here are a few exercises that have been investigated by researchers for their effects in Parkinson’s:
4. T’ai chi and yoga
These sorts of exercise are called ‘mind-body’ exercises, as if done correctly they improve the strength, balance, flexibility and stability of your body while using the movement or postures to generate mindfulness. The duality of the ‘mind-body’ approach enhances both physical and mental health.
There is evidence that people with Parkinson’s who practised t’ai chi for 6 months improved their balance and were less likely to fall, and other benefits may include improvements in movement and other motor symptoms of Parkinson’s.
Similar benefits are also reported for yoga, with additional improvements reported for depression and quality of life. And with seated as well as standing yoga poses of different difficulties, there is something for everyone.
You can find T’ai Chi and Yoga classes in your area on the Parkinson’s UK website.
Pilates is a system of physical conditioning involving low-impact exercises and stretches designed to strengthen muscles of the torso. In classes designed for people with Parkinson’s it can be performed with specialised equipment.
Studies investigating the specific benefits of Pilates in Parkinson’s have ranged in duration from 5 weeks to 12 months, and often involved up to 3 hours of exercise per week. Overall the research suggests that this activity can improve muscle strength, walking, mood, overall fitness and quality of life. There is also some evidence that it may improve balance, flexibility, and reduce the risk of falls.
To find a pilates class near you, visit the Parkinson’s UK website.
6. Weight and resistance training
It is known that the extensor system — the muscles that keep the body upright against gravity — become weaker in Parkinson’s, making it more likely that the body will become stooped and flexed. Lifting weights or using resistance equipment can be the simplest way to work on muscle strength, however it is important you know what you are doing so you don’t hurt yourself, and so that you strengthen the right set of muscles.
These exercises normally focus on building strength in sets or muscles or improving certain movements. And can often be done at home without the need of expensive equipment. If you are interested in doing weight and resistance exercises we advise getting professional advice about what muscles or movements to work on from a qualified physiotherapist.
There is evidence that this type of exercise can improve strength and flexibility in Parkinson’s. For instance, resistance training focusing on the legs was seen to improve leg strength and mobility of the knee joint in people with Parkinson’s. But the researchers in this study noted it may not be superior to treadmill or balance training, which provided many of the same benefits.
Other researchers have demonstrated that a combined strengthening, stretching and balance training programme, carried out 2 days a week over 24 months, may be more effective than weight lifting alone in reducing Parkinson’s motor symptoms.
Other strengthening and flexibility activities
There are many more activities that help to build strength and flexibility that may be of use to people with Parkinson’s, but many have not been researched to find out about their specific benefits in the condition. You can visit our forum to read experiences of exercise programmes people have tried, and join in the conversation.
Are there any Parkinson’s specific exercises?
There are a number of Parkinson’s specific programmes that aim to improve movement. Overall there is limited research evidence on the specific benefits of these programmes, and we don’t yet know if they are more beneficial than other types of exercise, but people have told us they found them to be of use.
We have provided examples below of the more common programmes specific to the needs of people with Parkinson’s, but you may find classes with different names that are run by physiotherapists near you and offer similar exercises by trained therapists.
LSVT®BIG training is administered over the course of a month by a qualified physiotherapist or occupational therapist. It involves repetitive intensive high-amplitude (big) movements and aims to restore normal movement amplitude. Studies into LSVT BIG training have been small in size but there is some evidence it may improve daily activities and motor symptoms.
It is claimed that this training provides greater improvements in motor performance than either Nordic walking or non-supervised in-home exercises. However, another study found that an 8-week Nordic walking course and a 4-week LSVT BIG course produced similar improvements in reaction time.
PD Warrior is exercise treatment designed to slow Parkinson’s down. It was developed by Australian physiotherapists but practitioners can now be trained in the UK. It’s a complete rehab program designed to improve your function, quality of life and long term exercise behaviour.
Conductive education helps people with neurological conditions, such as Parkinson’s, to develop their movement, speech, and cognitive ability. During the programme, specialist equipment is used to help people find ways to improve their movement.
Boxing training is a type of non-contact fitness training designed to help build strength, lessen symptoms and allow people to lead a healthier and happier life. A small scale observational study showed 12 weeks of training could produce measurable improvements in gait, balance, and quality of life.
Whatever activities you take part in, we hope you find something you enjoy.
Visit parkinsons.org.uk/exercise to find more information about the best exercise for you.
We’ll leave you with some general tips to keep in mind when exercising. You can discuss these with a health professional before starting a exercise programme:
Tips for exercising
- Remember to warm up before exercising and cool down afterwards.
- Exercise isn’t just for your body — activities, such as singing, can help exercise your facial muscles, jaw, and voice as well.
- Work out in a safe environment. Slippery floors, poor lighting and throw rugs are examples of potential dangers.
- If you have difficulty balancing, try using a wall or other solid support.
- Don’t be upset if you cannot perform as well as you would like at first. Start with shorter periods of exercise and build up from there, you will soon start to see improvements.
- Be honest with your specialist and/or physiotherapist. If a a movement or particular type of exercise feels unnatural, too difficult, or hurts, tell them. Professionals with training in Parkinson’s and exercise can advise if you are doing the exercise properly or advise different exercises to avoid injury.
This blog is not meant as health advice. You should always consult a qualified health professional or specialist before making any changes to your medications or lifestyle.